Globally millions of people sink into debt & poverty because of unaffordable healthcare. Read about this inequality here http://bit.ly/1QnyXIo
At the Community Health Centre, Sahvara block in Dhanbad district of Bihar, sitting beside her daughter- in-law Neelu who’s just delivered a baby, Sita Devi appeared quite dejected. She had to purchase medicines worth Rs. 1100.00 (US $16) from a medicine shop outside the hospital, as she was told by the hospital staff that free medicine stock in the public hospital has exhausted. For Sita Devi, a landless farm labourer from a nondescript village Mankauli, the amount was a big sum and equal to- her earnings of almost two weeks.
The situation at the city’s landmark Darbhanga Medical College & Hospital that has earned Darbhanga its popular name “Medical City”i , is no different than the Community Health Centre, Sahvara. Free essential medicines to poor patients are not regularly available at the hospital’s Maternity & Gynecology Ward. At the Generic Medicine Store, built several years ago in the same campus to provide lifesaving cheaper generic medicines to the public, shelves are gathering dust and the locks rusting as the store has never been functional. Consequently, the hapless health care seekers’ have to purchase costly medicines from private medical stores proliferating outside the hospital campus.
Darbhanga is the fifth largest city of Bihar and also the second biggest medical hub of Bihar. Millions of health care service seekers like Sita Devi in the state of Bihar and across the country are aware that public health care facilities have provision for free and cheaper options for lifesaving medicines but these remain inaccessible to the poor and needy.
Darbhanga or Bihar are not the exceptions. It is paradoxical that even as India has earned its global identity as “Pharmacy of the Global South”, 63 million people sink into poverty each year as a result of unaffordable health care costs. Over 40% of those hospitalised have to borrow money and/or sell assets to meet the cost of treatment. In fact health care is the second-most leading cause of rural indebtedness in the country, after dowryii . Private expenditure by households account for 65% of the total expenditure on health care while government contribution is merely 35% of the expenditure. 66.4% of total out-of-pocket expenditure on healthcare is on medicines. Over 23% of the sick do not seek treatment because they simply cannot affordiii .
While billions of people across the globe are entrapped in the vicious cycle of debt and poverty because of high out of pocket expenditure on health care, a few on this planet have become billionaires by investing in pharma business. According to Oxfam’s report on growing inequality in the world, between 2013 and 2014 billionaires listed as having interests and activities in the pharmaceutical and healthcare sectors saw the biggest increase in their collective wealth. Billionaires listed as having interests or activities in the pharmaceutical and healthcare sectors increased their collective net worth by 47% between March 2013 and March 2014. The richest 10 billionaires (ranked in 2013) have made (at least part of) their fortunes from activities related to the pharmaceutical and healthcare sectors
According to the 2015 Oxfam Report- AN ECONOMY FOR THE 1%ivreleased recently, intellectual property, especially patents, is strongly guarded by the pharmaceutical industry, one of the most profitable industries globally and one that has helped more than 90 individuals become billionaires. As new medicines can be time-consuming and expensive to develop, pharmaceutical companies consider IPR ( Intellectual Property Rights) as almost the only incentive for them to invest in research and development (R&D). IPR prevents other companies from producing the same drugs, effectively giving the IP holder a monopoly and hence the ability to dictate prices – in practice determining who can access a medicine and who cannot. By creating a monopoly, IPRs also create incentives for ‘Big Pharma’ to maximize its profits by charging inflated prices, at the expense of sick and vulnerable people. While IPR are supposed to stimulate innovation, in reality, the system is driven by commercial interests and not by public health. These companies explicitly use their resources for influence through the direct lobbying with governments, particularly on issues and policies which affect their business interests. No wonder that the Indian government and pharma companies are under pressure from international pharmaceutical lobbies to change their intellectual property (IP) policies to limit the use of public health safeguards enshrined in its domestic laws.
As the global billionaires, corporate honchos, influencers and leaders gathered at Davos during World Economic Forum recently to discuss policies towards shaping the global, regional and industry agenda, they must negotiate a new global treaty on research, development and the pricing of medicines, commit to increase investment in creating affordable essential medicines and exclude intellectual property rules for essential medicines from trade agreements so that Sita Devi of Dhanbad and many others like her around the world have access to affordable medicines. This is a prerequisite to one of the key challenges WEF recognizes – How to ensure healthy lives and health security for 9.7 billion people on this planet? This also resonates with Sustainable Development Goal #3 on Good Health & Well Being that the world leaders have committed to reach.
Written by: Farrukh Rahman Khan, Lead Specialist- Essential Services, Oxfam India
[ii] All-India Drug Action Network (AIDAN) Drug Pricing Policy Brief
[iii] India Infrastructure Report 2013-14-The Road to Universal Health Coverage,
[iii] Draft National Health Policy 2015, Government of India
[iii] World Medicine Situation Report 2011